When do I need a fusion

Dr. Mark R. McLaughlin
Princeton, NJ
This is a very controversial question. I believe that when a discectomy is performed on the cervical (upper neck) spine that a fusion should be performed. This fusion re-establishes the normal alignment of the spine and maintains or increases the size of the channels that the nerves come out of. Also, I believe that a fusion can decrease the chances of delayed neck pain after discectomy alone.
Dr. Brian Subach
Atlanta, GA
In case of severe degenerative disc disease, most neck pain may arise from the progressive loss of disc height and compression of neural structures. If instability is present, a fusion is indicated.
Dr. Kevin Yoo
Escondido, CA
You need a fusion if a disc or vertebra in your neck needs to be removed to relieve the pressure on your nerves and/or spinal cord. In some cases, these structures can be removed without the need for fusion. There are certain conditions that can be treated without fusion. Ask your surgeon if you are a candidate for this treatment option.
Dr. W. Christopher Urban
Glen Burnie, MD
A patient may require a cervical fusion when neck or arm symptoms become debilitating and fail to respond to non-operative therapy. These symptoms such as arm pain, numbness or weakness could be caused by a variety of conditions, such as disc herniations, traumatic injuries, tumors, or spinal instability. For these conditions, fusions have proven to provide excellent short and long-term outcomes. A fusion eliminates instability, restores spinal alignment, and relieves nerve root compression. As a result of improved instrumentation and safer preparation of allograft tissue, fusions are done with greater success and less pain compared to techniques that involve bone graft harvesting. There are other conditions, such as a far lateral disc herniation, where only decompression of the nerve root is required.
Dr. Kambiz Hannani
Los Angeles, CA
In the cervical spine, fusions are used when disc or bone needs to be removed to take pressure off of the nerves or spinal cord through an anterior approach. The anterior approach involves approaching the neck from the front rather than the back. Fusion improves the long term results depending on the problem at hand.
Dr. Jeffrey C. Wang
Los Angeles, CA
Fusions are often performed when there is significant degeneration or instability which causes significant pain or discomfort. Many times the disc areas are fused when the discs are worn out and there are significant degenerative changes in the surrounding bones. Fusions are also performed when surgery involves decompressing the nerves which results in the need for stabilization of the surgical area with a fusion.
Dr. Paul Saiz
Mesa, AZ
A fusion is typically needed when a decompression of the spinal cord in the neck is performed. This is typically done anteriorly, which involves removing the disc which is anterior to the spinal cord. Because the disc has been removed, typically bone is placed into that gap requiring a fusion. Fusion also is needed whenever there is instability which refers to excessive motion between one vertebra in relation to another.
Dr. Timothy C. Ryken
Iowa City, IA
If your surgeon feels you have instability or are at significant risk for developing instability of the spine.
Dr. Theodore A. Belanger
Charlotte, NC
Your spine specialist will best be able to determine when a fusion is necessary. In general, a fusion is done to treat or prevent instability of the spine, which may be present, initially, or an expected result of surgery. Instability of the neck part of the spine can have serious consequences, so fusion may be done to prevent it.
Dr. Moe R. Lim
Chapel Hill, NC
In general, fusion is necessary when there is painful motion, instability, or potential for instability.
Dr. Rick Sasso
Indianapolis, IN
The vast majority of the time now, today if a disc herniation is removed from the front of the neck, which is the standard way that it is done, a fusion is performed at the same time. The reason is that we want to place that segment that motion segment in the best position. What happens we've talked about is the disc degenerates, it starts to collapse, and that is when the disc herniates. Not only is the disc herniation pressing on the nerve, but, because the disc has collapsed, the tunnel where nerve runs out also is narrowed. So, when we take the disc herniation away from the nerve, we also distract that disc back where it belongs and open up the tunnel where the nerve runs out, so it's another way of taking pressure off the nerve. Then a bone block is placed across that segment to keep that foramen or tunnel where the nerve runs out open. The purpose of the fusion is to place the nerve in the best possible position for it to recover and then prevent any further problems in the future.
Dr. Daniel Resnick
Madison, WI
The decision to perform a cervical fusion for patients with disc disease is complex and not really answerable in a single paragraph. Depending upon the shape of your spine, the nature of the disc disease that you have, and your symptoms, your surgeon may or may not opt to perform a cervical fusion at the time of a discectomy. Not every patient who has a cervical discectomy requires a fusion. There are both anterior and posterior approaches that do not require the performance of a fusion. However, fusions are commonly performed and are extremely useful in patients with significant loss of disc space height, deformity of their neck, significant neck pain in addition to radicular symptoms and in patients who the anatomical position of the disc makes a posterior approach typical to dangerous.
Dr. Dennis G. Crandall
Mesa, AZ
Fusing painful joints may help get rid of neck pain. Fusion is appropriate after cervical discectomy or spinal cord decompression in order to stabilize the neck, potentially preventing neck pain, and protect the nerves from getting pinched again.
Dr. Allan Levi
Miami, FL
A fusion is indicated in most instances when a cervical disc is removed from an anterior approach. A fusion can often help pre-existing neck pain and prevents problems with recurrent disc herniations at that level in the future.
Dr. David S. Baskin
Houston, TX
This is also a question that depends on the anatomy of your problem, and should be discussed with your doctor. A fusion is mandatory if there is significant instability in your spine. Many doctors believe that a cervical fusion is also indicated when there is a considerable amount of neck pain as part of the problem, and that without a fusion, more neck pain will persist after surgery.
Dr. Joseph Alexander
Winston-Salem, NC
If a patient has been demonstrated to have significant instability or slippage of the spine, a fusion is generally necessary. In other circumstances, such as the treatment of a herniated disc or other degenerative problems of the spine, spinal fusion may be an option. These issues would have to be discussed between an individual patient and his or her surgeon, having taken into account the unique spinal anatomy, degeneration and symptoms involving that particular patient. The range of options available is too wide to generalize on this topic.
Dr. Douglas Slaughter
Mesa, AZ
Patients need a fusion for instability of the spine and at times for some neurologic problems.
Dr. John Peloza
Dallas, TX
Whether or not a patient needs a cervical fusion depends on what the specific diagnosis is and the patient's response to treatment. In general, if you have failed conservative care then a fusion may be considered. Fusions essentially immobilize the tissues that allow motion at a spinal segment. The majority of the time, a fusion is done after a disc is removed in the cervical spine and a bone graft is put in its place. Most fusions in the cervical spine are done from the anterior, or front, approach. Fusions are indicated for conditions such as severe degenerative disc disease with spinal cord compression, deformity of the cervical spine, tumors, and infections. They are also done because of trauma where there is a possibility of fracture or dislocation of the spine or the cervical spine is rendered unstable. Fusions can also be done from the posterior, or back-side, of the neck for any of the above named reasons as well as inflammation, neoplasm or for congenital problems in the neck.
Dr. Sebastian Lattuga
Rockville Centre, NY
In my opinion, the best procedure to treat patients with cervical disc disease is the anterior cervical diskectomy and fusion (ACDF). The fusion component of this procedure is vital to the short and long term success of the surgery. Fusion is important because it stabilizes the vertebrae in their original and proper spatial relationships and prevents the possibility of patients developing recurrent pain at that level.
Dr. Mark Testaiuti
Haddonfield, NJ
Usually when a disc is removed from the front a fusion is done to restore the height and normal alignment of the spine and to aid in faster healing time. Occasionally a disc is removed from the back and a fusion is not needed.
Dr. Sean Salehi
Chicago, IL
When there is instability such as after a trauma, or if the surgery is done through the front of the spine, then the majority of surgeons also fuse the spine at the same time.
Dr. Jeffrey Goldstein
New York, NY
My feeling is that when the disc gets completely removed from the front of the spine that a fusion is necessary. There are some surgeons, I think who are in the minority, who will remove a disc and decompress the nerve anteriorly without doing the fusion. A posterior fusion is necessary if there is any evidence of instability. So whether or not a patient needs a fusion depends on what the underlying problem is and what the surgical approach is and whether or not there's associated instability.
Dr. B. Theo Mellion
Carbondale, IL
My feeling is that whenever the disc gets completely removed from the front of the spine then a fusion is absolutely necessary. There are some surgeons who will remove a disc and decompress the nerve anteriorly without doing the fusion, but that is not the way I would approach that problem. A posterior fusion is necessary if there is any evidence of instability or pain with motion that cannot be treated with an anterior procedure. Whether or not a patient needs a fusion depends on the underlying problem, the surgical approach, and whether or not there is associated instability.
Dr. Randy Davis
Glen Burnie, MD
Fusion in the neck is frequently used for patients who have a significant amount of neck pain in addition to arm pain and they have what is frequently called mechanical symptoms. Patients who have only arm pain and a pinched nerve may not require a fusion.
Dr. Robert S. Pashman
Los Angeles, CA
The treatment plan is individualized for each patient. A fusion becomes necessary when there is instability in the spine. This may occur because of degeneration of the disc, a spinal deformity such as spondylolysis, or as a result of removing a disc during surgery. A fusion is performed to reconstruct the spine's natural balance and curvature (lordosis). Instrumentation such as screws and plates may be used to stabilize the spine while the boney fusion grows.

The commentary above recounts the experiences of these physicians. Medtronic invited them to share their stories candidly. Keep in mind that results vary; not every patient's response is the same. Talk with your doctor to learn more about any products that are mentioned above.

It is important that you discuss the potential risks, complications and benefits of spinal surgery with your doctor prior to receiving treatment, and that you rely on your doctor's judgment. Only your doctor can determine whether you are a suitable candidate for this treatment.

Published: May 04, 2007
Updated: April 19, 2010